Death Walks the Halls

How do you deal with a dying patient?

The first-hand account of a new nurse dealing with the dying patient on a busy telemetry floor. Written in real time throughout the night.


How do you deal with a dying patient?

Death walks the halls tonight.

It is not our first encounter. I recognize his presence. I picture him pacing up and down, for he is patient, and can wait as long as he needs for us. We can try to stop him, but we never will. At best, we can trick him, maybe he can leave, maybe he just waits. But one day he will return to continue his hunt.

On any other patient, who lacks a signed DNR, she would be in the ICU no questions asked. Her blood pressure is dropping; 79-45-77. Her breaths are shallow and irregular, but her non-rebreather mask keeps her saturation in the mid 90’s. I give her morphine to ease her gasping, but she continues to do the same. Eventually, she can close her eyes to sleep and I wonder if she will ever speak again? What were the last things she said, and to whom? At least she can nod. She hasn’t shaken her head yet though; what if that’s all she can do right now?

She looks like every other patient I have seen that has died on this unit. Her limbs are cold. Her whole body has severe swelling. The edema on her extremities forms to any pressure. On could sign their name on her legs with their finger and the impression would last for hours. Her stomach is distended far beyond what it should handle. It is hard with a spring, like a red dodgeball. Her labs show how hopeless this case is. Her organs are failing, she is deadly acidotic. I pray she is not suffering too much. One never knows the true pain of passing until it is too late.

She is younger than my own mother. Her family came up by her side and paced the room as I lay my stethoscope to listen to her raspy breaths. Her daughters are stricken with grief. This day was to come, but they never thought so soon. You think you can prepare for when this moment occurs. But, when that day finally presents its darkened face you realize: you are weak, and you are forced to witness the harsh reality of mortality; a trait we are all burdened with.

Throughout the night her pressure continues to drop. 66-58-56. The heart monitor shows her pacemaker working flawlessly to keep what at her age should be a very healthy organ, alive. It beats without fail in perfect sinus. 90-90-90. Does the pacemaker make the dying process longer? I can’t help but wonder. 90-90-90. Funny how resilient the heart is; how it will pump hard until your last moment. They don’t get the credit they deserve.

Her family has gone home now. It’s just I, and what little presence she continues to have. I rest my palm on her chilly hand. The human touch is such a sacred thing in this world, but I can’t stay like this for long and a force draws my hand away. If I get attached, this job will become impossible.

I have other patients to tend to. People who are having the most miserable days of their lives. And I must provide the same amount of compassion to them all. Can a single person run out of compassion? I suppose so. We always hear about compassion fatigue plaguing the healthcare worker. Perhaps true genuine compassion in a certain amount of time will inevitably run dry. But, I can put on a smile in every room. Even if it's fake, I don’t think they know. If only they knew what was happening right now just a few yards down the hall.

When I return to that grim room down the hall I gently lift the sheets to take her vitals; she opens her eyes and stares into mine. She raises her arm as the cuff begins to squeeze; the most reaction I have gotten from her this whole night. I ask if she hurts but she only stares. I pray she nods to let me give her some morphine but her heavy lids close again as she returns to her slumber.

There is an eerie stench in the room. It smells rotten and familiar. Every patient that has died on this floor with hospice care has it. It is death; waiting in the doorway behind me. But I am all too familiar with his presence lurking these halls. I know his tactics, his ins, and outs, its what I have spent years mastering. I watch my patient struggle to breath; he patiently waits for his chance. There is only one thing on my mind: Not today, not my shift.


Photo credit: Robert Reid (1918)

Kyle Fitz is a Chicago based nurse graduating in 2016. He spent 2 years on a medical surgical telemetry floor with a strong focus on orthopedic surgery before switching to intensive care. He now is advancing his education. On nights that are "slow," he carries a black book where he writes his experiences down to help ease the burden of caring for such sickly individuals.

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Specializes in critical care, med/surg. Has 37 years experience.

One of my nursing students recently had a run in with the darkness. Had it not been for her colleagues, myself and the nursing staff, she may have imploded. She wants to be a mother baby nurse and had never the occasion to experience death. She told me that she did not like adults and was much better with kids and moms. She actually texted me and said that she thought we should not be on the floor while this was happening. We took a long walk outside around the campus and among other things I told her that death is not partial to the elderly. She recounted a family member of a friend who she had witnessed some of the grief with and said it was like she knew it was there but until that day she had kept it at bay. As we all know, who have had patients die despite our best efforts, the more we talk about it doesn't make it go away either, but it does help our psyche's heal enough to continue caring.

Thank you for that wonderful story.

2BS Nurse, BSN

677 Posts

Has 10 years experience.

Beautifully written!

"Organichombre", how lucky this student is to have you as an instructor! A nursing instructor who takes a walk with her student and encourages her to express her feelings? Going through nursing school boot camp, I felt that I needed to constantly show how strong I was (physically and emotionally) to pass my clinicals.

Skittles767, RN

1 Article; 24 Posts

Specializes in Critical Care. Has 2 years experience.

Thank you all!

Has 12 years experience.

Well done! Here's an alternate viewpoint.

Life is a transient gift, we keep it for our allotted time then it must be returned to the (source -maker -deity -cosmos -infinity). Like rain falls to the river and then returns to the sea.

Death is not an enemy, he is part of the eternal cycle.


16 Posts

Has 45 years experience.

Excellent, compassionate article. Thank you for sharing your experience.


VivaLasViejas, ASN, RN

142 Articles; 9,979 Posts

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

Well-written and full of compassion. The only thing I think may not have been considered is the fact that there really are some fates worse than death---namely, going on like this patient did. Sometimes when life has become a burden and there is nothing left but suffering, death comes like a friend to release us from our pain and distress. Yes, our instinct as nurses is to fight it, but our bodies are designed to be used for a given number of years and then they wear out. It is no kindness to keep flogging a failing heart, kidneys, lungs and so on when it's our time to go. That's why I found ICU nursing so depressing; so many desperately ill patients, so few DNRs. I'm against assisted suicide, but there are times when allowing nature to take its course---with excellent comfort care, to be sure---is in the patient's best interests.

Just a few of my thoughts. Otherwise, I enjoyed this article and encourage the OP to keep writing!

Specializes in ICU, trauma, neuro. Has 15 years experience.

Death is only depressing if we take a "materialistic" perspective that doesn't recognize the eternal nature of the human spirit. The alternative perspective is that "the other side" is more real than this world and when we "transition" we are actually moving into the world of spirit, of life and leaving this dismal abode of temporary habitation.


144 Posts

Specializes in Hospice. Has 6 years experience.

Death is not the enemy. Death is a part of life. The only two things we MUST do in this life are be born and to die. There are stages to death as there are stages in birth. As professionals, we have a duty to recognize these stages and assist our patients through them. Medicine is helpful when it enhances and improves life - even at a short term cost for a longer term gain. When it ceases to provide gain, it is time to begin the management of death.

You have written beautifully and the sacredness of death, as the sacredness of birth, shines through your writing. But please, lets stop thinking of death as an enemy.

Beautifully, wonderfully written....but I must disagree with the end- if death came tonight, on yourshift, it would be the kindest, most compassionate thing for that patient. I know allowing death to happen goes against nursing instinct, but its reality. When I tell people I've spent almost 12 years working with hospice patients, the #1 question is this- "how do you do it?"

I do it understanding that this is the natural process....that my patients are trapped in a broken body that no longer serves them and, in fact, is causing them pain....and that in death, there is freedom and peace. Best wishes on your journey ❤